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Ophthalmology. Glaucoma 2023To examine the generalizability, discuss limitations, and critically appraise recommendations on the management of primary angle-closure suspects (PACSs) that emerged as... (Review)
Review
PURPOSE
To examine the generalizability, discuss limitations, and critically appraise recommendations on the management of primary angle-closure suspects (PACSs) that emerged as a result of recent randomized clinical trials challenging the widely accepted clinical practice of offering laser peripheral iridotomy (LPI) to PACS patients. To synthetize findings from these and other studies.
DESIGN
Narrative review.
SUBJECTS
Patients classified as PACS.
METHODS
The Zhongshan Angle-Closure Prevention (ZAP)-Trial and the Singapore Asymptomatic Narrow Angle Laser Iridotomy Study (ANA-LIS) along with accompanying publications were reviewed. Epidemiologic studies reporting on the prevalence of primary angle-closure glaucoma and other precursor forms of the disease were also analyzed along with publications reporting on the natural course of the disease or studies reporting on outcomes after prophylactic LPI.
MAIN OUTCOME MEASURES
Incidence of progression to more severe forms of angle closure.
RESULTS
Patients recruited in recent randomized clinical trials are asymptomatic, do not have cataracts, may be younger, and have, on average, deeper anterior chambers depth compared with patients treated with LPI in clinics.
CONCLUSIONS
The ZAP-Trial and ANA-LIS clearly represent the best available data on PACS management, additional parameters however may need to be considered when physicians face patients in clinic. PACS patients encountered at tertiary referral centers may represent more advanced cases with respect to ocular biometric parameters and may be at higher risk for disease progression compared with those recruited through population-based screening.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Topics: Humans; Iris; Intraocular Pressure; Glaucoma, Angle-Closure; Ophthalmologic Surgical Procedures; Lasers
PubMed: 37321374
DOI: 10.1016/j.ogla.2023.06.004 -
Scientific Reports Nov 2022Acute primary angle closure glaucoma is a potentially blinding ophthalmic emergency requiring prompt treatment to lower the elevated intraocular pressure in humans and...
Acute primary angle closure glaucoma is a potentially blinding ophthalmic emergency requiring prompt treatment to lower the elevated intraocular pressure in humans and dogs. The PACG in most of canine breeds is epidemiologically similar to humans with older and female patients overrepresented with the condition. The American Cocker Spaniel (ACS) is among the most common breeds observed with PACG development in dogs. This study initially sought to identify genetic risk factors to explain the high prevalence of PACG in ACSs by using a case-control breed-matched genome-wide association study. However, the GWAS failed to identify candidate loci associated with PACG in this breed. This study then assessed intrinsic ocular morphologic traits that may relate to PACG susceptibility in this breed. Normal ACSs without glaucoma have a crowded anterior ocular segment and narrow iridocorneal angle and ciliary cleft, which is consistent with anatomical risk factors identified in humans. The ACSs showed unique features consisting of posterior bowing of iris and longer iridolenticular contact, which mirrors reverse pupillary block and pigment dispersion syndrome in humans. The ACS could hold potential to serve as an animal model of naturally occurring PACG in humans.
Topics: Dogs; Humans; Animals; Female; Glaucoma, Angle-Closure; Genome-Wide Association Study; Plant Breeding; Iris; Glaucoma, Open-Angle; Acute Disease; Intraocular Pressure
PubMed: 36348026
DOI: 10.1038/s41598-022-23238-1 -
American Journal of Therapeutics 2020
Topics: Antihypertensive Agents; Drug Therapy, Combination; Female; Glaucoma, Angle-Closure; Humans; Low Back Pain; Middle Aged; Mydriatics; Myopia; Ophthalmic Solutions; Optic Nerve; Topiramate; Ultrasonography
PubMed: 32039989
DOI: 10.1097/MJT.0000000000001004 -
Indian Journal of Ophthalmology Jul 2022
Topics: Choroid Diseases; Choroidal Effusions; Glaucoma, Angle-Closure; Humans; Lupus Erythematosus, Systemic
PubMed: 35791193
DOI: 10.4103/ijo.IJO_299_22 -
European Journal of Ophthalmology Jan 2022Vogt-Koyanagi-Harada (VKH) is an autoimmune disease with bilateral granulomatous uveitis and various systemic manifestations. Bilateral acute angle closure glaucoma...
PURPOSE
Vogt-Koyanagi-Harada (VKH) is an autoimmune disease with bilateral granulomatous uveitis and various systemic manifestations. Bilateral acute angle closure glaucoma (AACG) can be a rare initial manifestation of VKH that may be misdiagnosed as primary angle closure glaucoma (PACG).
CASE REPORT
A 62-year-old woman with bilateral painless loss of vision referred to Qingdao Municipal Hospital. She had been diagnosed as PACG before admission and prescribed with anti-glaucoma treatment which did not improve her symptom. She had severe bilateral uveitis, optic disk swelling, and serous retinal detachment in both eyes. Intraocular pressure (IOP) was 20 mmHg in the right eye and 23 mmHg in the left eye, and her best corrected visual acuities (BCVAs) were 0.02 in both eyes. She was treated with oral corticosteroid therapy on a tapering schedule. One month after the therapy, the IOP remained well-controlled with deepened anterior chamber. Her visual acuity and symptom were improved.
CONCLUSIONS
We experienced a case of VKH disease with an unusual presentation of bilateral secondary AACG. It is important for ophthalmologists to know about this rare cause of painless loss of vision so that it could be treated properly.
Topics: Female; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Middle Aged; Tonometry, Ocular; Uveomeningoencephalitic Syndrome; Visual Acuity
PubMed: 32811185
DOI: 10.1177/1120672120951442 -
The Mount Sinai Journal of Medicine,... 1997
Topics: Glaucoma, Angle-Closure; Humans; Male; Middle Aged
PubMed: 9293740
DOI: No ID Found -
Annals of the Academy of Medicine,... Mar 2008Primary angle-closure glaucoma (PACG) is a major cause of blindness among Asians. A better understanding of the disease will improve the treatment and outcome of this... (Review)
Review
INTRODUCTION
Primary angle-closure glaucoma (PACG) is a major cause of blindness among Asians. A better understanding of the disease will improve the treatment and outcome of this condition.
METHODS
A literature review of all recent publications on PACG was carried out. Articles were retrieved using a key word search of MEDLINE, PubMed and Science Citation Index databases.
RESULTS
Following laser peripheral iritodomy for acute angle-closure, Asians were found to have a higher tendency to develop a subsequent rise in intraocular pressure compared to Caucasians. Furthermore, the extent and severity of visual field damage was more severe in Asians than Caucasians, particularly in eyes that presented insidiously with chronic PACG. Prophylactic laser iridotomy in the contralateral eye was found to be highly effective in preventing acute angle-closure attacks.
CONCLUSION
PACG is more difficult to manage and is associated with more severe long-term visual morbidity in Asians than Caucasians. Regular follow-up of patients with PACG is important for the early detection of progression of the disease and visual field deterioration.
Topics: Asian People; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iridectomy; Ocular Hypertension; Visual Fields; White People
PubMed: 18392300
DOI: No ID Found -
Ophthalmic Genetics Oct 2018X-Linked Retinoschisis (XLRS) is a common genetically determined form of macular degeneration affecting young males. XLRS is due to mutations in the RS1 gene located on...
X-Linked Retinoschisis (XLRS) is a common genetically determined form of macular degeneration affecting young males. XLRS is due to mutations in the RS1 gene located on chromosome Xp22 which codes for retinoschisin and is estimated to affect between 1:5000 to 1:20000 individuals worldwide. We report a case of refractory angle-closure glaucoma in a thirty-nine-year-old Caucasian man with atypical XLRS. The patient presented with a two-day history of left eye pain, acutely reduced vision and a nine-month history of hemicranial pain. Examination identified left intraocular pressure (IOP) of 52mmHg. Gonioscopy confirmed complete angle closure. Following failure of medical management and persistently raised left IOP (43-46mmHg), the patient underwent left phacoemulsification and intraocular lens insertion without complication. After surgery, his IOP reduced to 10-14mmHg on all follow up examinations without the need for glaucoma drops. His iridocorneal angle remained open and vision improved to 20/100. Our case demonstrates the additional role of lens surgery in the treatment of secondary angle-closure glaucoma in the presence of an inherited retinal dystrophy. All patients with inherited retinopathy presenting with a headache or eye pain should undergo gonioscopic examination to exclude angle-closure glaucoma.
Topics: Acetazolamide; Adult; Anticonvulsants; Glaucoma, Angle-Closure; Humans; Male; Retinoschisis; Treatment Outcome
PubMed: 30081704
DOI: 10.1080/13816810.2018.1490961 -
Acta Ophthalmologica Mar 2019To investigate whether the peripheral thinning and shrinking of the iris as induced with Argon laser peripheral iridoplasty (ALPI) has an effect on intraocular pressure...
PURPOSE
To investigate whether the peripheral thinning and shrinking of the iris as induced with Argon laser peripheral iridoplasty (ALPI) has an effect on intraocular pressure (IOP), angle structure and 3-D anterior segment (AS) morphology in Caucasians with chronic primary angle-closure (PAC) and primary angle-closure glaucoma (PACG).
METHODS
Twenty-four eyes of 24 patients (age 67.7 ± 8.9 years; seven males; 17 females) diagnosed with PAC (n = 10) or PACG (n = 14) were assigned for ALPI prior to laser peripheral iridotomy (LPI) and consecutively enrolled in this prospective interventional study. Intraocular pressure (IOP) was measured with Goldmann applanation tonometry, angle structure with gonioscopy using the Shaffer grading system and AS morphology with the Pentacam rotating Scheimpflug camera prior to and 3 months after ALPI. Intraocular pressure (IOP)-lowering medication was not changed during follow-up.
RESULTS
Intraocular pressure (IOP) changed statistically significantly from 18.8 ± 3.6 to 14.7 ± 3.1 mmHg (p < 0.001). Gonioscopy showed a statistically significant angle widening in all four quadrants: nasally from Shaffer 1.04 ± 0.98 to 2.54 ± 1.1 (p < 0.001), superiorly from 0.39 ± 0.66 to 1.58 ± 1.21 (p < 0.001), temporally from 0.87 ± 1.01 to 2.17 ± 1.24 (p = 0.001) and inferiorly from 1.22 ± 0.74 to 2.75 ± 0.9 (p < 0.001). Pentacam parameters like anterior chamber depth, volume and angle did not increase statistically significantly.
CONCLUSION
Argon laser peripheral iridoplasty (ALPI) is a safe and effective procedure for reducing appositional angle-closure and thus IOP in nonacute PAC and PACG patients.
Topics: Aged; Chronic Disease; Female; Follow-Up Studies; Germany; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Iridectomy; Iris; Laser Therapy; Lasers, Solid-State; Male; Prevalence; Prospective Studies; Treatment Outcome; White People
PubMed: 30239139
DOI: 10.1111/aos.13878 -
Ideggyogyaszati Szemle Sep 2017Introduction - To present a rare case of bilateral acute angle-closure glaucoma secondary to duloxetine administered for the treatment of depression. Case presentation -...
Introduction - To present a rare case of bilateral acute angle-closure glaucoma secondary to duloxetine administered for the treatment of depression. Case presentation - A 46 year old woman developed bilateral closed angle glaucoma after 15 days of duloxetine usage. Intraocular pressures (IOP) were 52 and 55 mm Hg in right and left eyes respectively, with shallow anterior chamber and angle closure on gonioscopy. Discontinuing duloxetine treatment, initiation of antiglaucomatous treatment and bilateral Nd:YAG Laser iridotomy obtained normalized IOP and anterior chamber depth. Conclusion - Duloxetine, used in the treatment of depression can be responsible for acute angle-closure glaucoma by leading to mydriasis and ciliary effusion.
Topics: Antidepressive Agents; Duloxetine Hydrochloride; Female; Glaucoma, Angle-Closure; Humans; Middle Aged
PubMed: 29870629
DOI: 10.18071/isz.70.0358